Abstract
PURPOSE: This study developed and validated a nomogram integrating specific inflammatory and Epstein-Barr virus (EBV) DNA quantification to predict overall survival (OS) in patients with nasopharyngeal carcinoma (NPC) who experienced recurrence or metastasis within ten years after completing first-line treatment with nedaplatin. METHODS: The nomogram was constructed utilizing data from a retrospective cohort of 120 patients treated at The People's Hospital of Guangxi Zhuang Autonomous Region between January 2017 and December 2022. The predictive accuracy and clinical utility of the model were assessed through the concordance index (C-index), decision curve analysis (DCA), calibration plots, and time-dependent receiver operating characteristic (ROC) curves. RESULTS: Multivariate analysis revealed that an elevated albumin-to-globulin ratio (AGR) and lymphocyte-to-monocyte ratio (LMR) were significantly correlated with improved OS, whereas increased levels of alkaline phosphatase (ALP) and the presence of EBV DNA were associated with poorer prognostic outcomes. These four variables were integrated into a nomogram, which exhibited robust predictive accuracy, as evidenced by a C-index of 0.747 (95% CI, 0.689-0.805). This performance marked a substantial enhancement in discriminatory ability relative to the 8th edition UICC/AJCC staging system, which yielded a C-index of 0.566 (95% CI, 0.509-0.624). Additionally, the nomogram demonstrated satisfactory calibration, effectively stratified patients by risk (log-rank test, P < 0.001), and showed clinical applicability as confirmed through DCA. CONCLUSIONS: This study successfully constructed a nomogram model for patients with NPC who experienced recurrence or metastasis within ten years following the completion of first-line treatment with nedaplatin. This model functions as an adjunct to the 8th edition UICC/AJCC staging system and provides significant support for clinical decision-making processes.